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Published on: November 6, 2019
General Versus Local Anesthesia in Loop Electrosurgical Excision Procedures: A Systematic Review and Meta-Analysis
Rafaela Germano Toledo, Yasmin Dias1, Rafael R H Martin
1Department of Obstetrics and Gynecology, University of Missouri Kansas City, Kansas City, MO.
Local anesthesia (LA) may be preferable for loop electrosurgical excision (LEEP) procedures. While general anesthesia (GA) showed minimal, non-significant improvements in pain and satisfaction, it was linked to larger excisions, potentially impacting future pregnancies.
Area of Science:
- Gynecology
- Surgical Oncology
- Anesthesiology
Background:
- Loop electrosurgical excision (LEEP) is the standard treatment for high-grade cervical intraepithelial neoplasia.
- Patient-reported outcomes are crucial for evaluating anesthesia choices in LEEP procedures.
Purpose of the Study:
- To compare patient-reported outcomes, specifically pain and satisfaction, between local anesthesia (LA) and general anesthesia (GA) during LEEP.
- To assess the likelihood of patients choosing the same anesthesia method again post-LEEP.
Main Methods:
- A systematic review and meta-analysis of studies comparing GA and LA for LEEP.
- Searched PubMed, Embase, and Cochrane databases.
- Analyzed postprocedure pain, satisfaction, and cone volume using random-effects models.
Main Results:
- Six studies with 2169 patients were included (1536 LA, 633 GA).
- No statistically significant differences in postprocedure pain or patient satisfaction between GA and LA.
- GA was associated with significantly larger cone volumes (0.46 cm3 difference).
Conclusions:
- Neither GA nor LA demonstrated clinically meaningful differences in pain or satisfaction.
- Larger cone volumes with GA may pose risks for future pregnancies.
- Considering the higher risks and costs of GA, LA appears to be a preferable option for LEEP.
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